South Essex Special Needs Housing Association Limited (SESNHA)

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location only provided support for a small number of people with a learning disability or autistic people, and most of these people did not receive any support with the regulated activity of personal care. However, we assessed the care provision under Right support, right care, right culture, as it is registered as a specialist service for this population group.

About the service

South Essex Special Needs Housing Association Limited (also known as ‘SESNHA Care’) is a home care agency providing personal care to people in their own homes. The service operates in Essex across Basildon, Harlow, Castle Point and Rochford. The service provides support to people including those with a physical disability, sensory impairment, and / or those living with dementia. At the time of our inspection there were 161 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. During this inspection, 130 people were in receipt of personal care.

People’s experience of using this service and what we found

Right Support: People were supported to be independent as possible, through reliable and safely managed care visits which were designed to meet their needs and preferences. One person said, “I try and work together with the care workers as I still want to do things, so we work as a team.” People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Staff received training and supervision to support them to deliver individualised and person-centred care for people. This included specialist training in supporting people with a learning disability and people living with dementia. One person told us, “I am well respected and treated with dignity.” Systems were in place to identify and respond to people’s changing needs. One person’s relative said, “The office is very good at supplying care in advance when my relative needs to go to hospital at certain times.”

Right Culture: There was an open and positive culture at the service, which embraced change, improvement and continuous development. The registered manager had a clear vision and ambition for the service, and systems and processes for governance and oversight had been developed and embedded since the last inspection. The service worked effectively in partnership with people, their relatives and other health and social care professionals to support good outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Since the last inspection, the service has moved address and changed the location name from Aveley House to South Essex Special Needs Housing Association Limited. The last rating for the service under the previous name and at the previous premises was requires improvement (published 18 November 2021).

At our last inspection we recommended that the provider embeds safe recruitment practice and governance and oversight measures more widely, including analysis of themes and trends. At this inspection we found the provider had acted on these recommendations and made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

At the last inspection this service was rated as requires improvement in the key questions of safe and well-led. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for South Essex Special Needs Housing Association Limited on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about protocols for ‘as required’ medication.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aveley House is a domiciliary care agency providing personal care to 183 people in their own homes. The service covers a wide geographic area in Essex, including Castle Point, Rochford, Basildon, Basildon North, Brentwood, Harlow and Epping.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection, the provider was supporting 180 people with personal care.

People’s experience of using this service and what we found

Safeguarding systems and policies had improved. An audit system was being planned for staff recruitment files to identify existing gaps. A new electronic call monitoring and care planning system had significantly reduced missed and late visits. Infection prevention and control (IPC) measures had been introduced. Medicines were being managed safely and regularly audited. Detailed analysis of themes and trends had not yet been established.

Improvements had been made to training, supervision and appraisals, including for the management team. People received assessments of their care and support needs, and consent had been considered. Staff supported people with food and drink, giving people options and choice. The provider had acted on advice from the local authority to drive improvement.

People told us they felt safe and well cared for. Most people told us they had small teams of regular care workers to support them and who knew their needs. Feedback on the punctuality of visits was mixed but there were no examples given of missed visits. People told us care workers were kind, caring and competent.

Complaints were being logged with action taken. A revised policy was in place for meeting the Accessible Information Standard. Care plans and risk assessments were subject to regular review. Information on people’s interests and life stories were recorded to reduce the impact on people of social isolation. End of life training was provided by the hospice to a manager, to be cascaded to all staff.

A new registered manager was in post since the last inspection. Action had been taken to improve the culture of the service, and to be more open, transparent and consider lessons learned when things had gone wrong. Organisational reporting lines had been clarified. The registered manager was sending notifications to CQC as required by law. It needs to be demonstrated going forward that improvements made are embedded, developed and sustained.

We have made a recommendation about recruitment practices, analysis of themes and trends to drive improvement, and sustaining and embedding governance and oversight systems.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 10 November 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 November 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aveley House is a domiciliary care agency providing personal care to approximately 375 people in their own homes. At the time of inspection, the provider was unable to confirm the exact number of people being supported. The service covers a wide geographic area in Essex, including Castle Point, Rochford, Basildon, Basildon North, Brentwood, Harlow and Epping.

CQC only inspects services where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Safe and effective systems were not in place to ensure people received support as required. Safeguarding processes were not effective and people were at potential risk of harm due to the poor management of safeguarding concerns. People experienced late, missed or shortened calls, which impacted on their care and did not ensure their needs were met. There was no plan in place for extreme or sudden staff shortages.

The risk to staff and people using the service from COVID-19 had not been adequately assessed or measures put in place to reduce the risk. Staff did not have access to adequate and sufficient Personal Protective Equipment (PPE) to ensure people were protected from the risk of infection. Where incidents occurred, there was a lack of oversight and lessons were not learnt to reduce the risk of the incident re-occurring.

Although some staff told us they received supervision, these were not recorded, and staff meetings were not regularly held. Training was overdue in a number of areas, including on mental capacity. Staff had not received effective training in the management of risk relating to COVID-19. Staff were not seen to be fully supported, for example through a lack of COVID-19 risk assessments for those staff who may have underlying health conditions.

Although some people using the service and their relatives said staff were caring and kind, our findings did not always suggest a consistently caring service. This includes the risk of harm due to late, missed or shortened visits. People were asked for their views on the service through quality monitoring visits and calls, however improvements to people’s care were not always made as a result.

Management of the service was not cohesive. The provider failed to demonstrate openness and transparency at all levels of the organisation. The registered manager did not have full access to complaints, safeguarding concerns or the training syllabus to ensure that they had effective oversight of the service. The organisational structure was not followed, and reporting lines were unclear. Systems were disorganised and some records including staff files could not be found. The service was unable to demonstrate any analysis of themes and trends or how learning was shared with the staff team to ensure continuous improvement.

We have made a recommendation on the implementation of the Accessible Information Standard (AIS).

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 5 November 2019) and there was a breach of Regulation 17 (Good Governance). The provider completed an action plan to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns about infection control practice, safeguarding processes, missed and late calls and concerns related to management of the service and wider systems. A decision was made for us to inspect and examine those risks.

We inspected and found further concerns which impacted on other areas of the quality and safety of care. We widened the scope of the inspection into a comprehensive inspection which included all of the key questions.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, receiving and acting on complaints, fit and proper persons employed, staffing, good governance, notifications of events to the CQC and the duty of candour.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Aveley House is a domiciliary care service providing personal care to over 400 people at the time of the inspection.

The service was supporting over 500 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

At this inspection, we found that there was a lack of managerial oversight of the service. Effective quality assurance checks were not in place to enable the manager and senior staff to assess and monitor the quality of the service. The service arrangements were not robust as they had not recognised the issues we identified during our inspection.

The provision of planned staff supervision meetings and appraisals were not consistent. Training was provided but some practical elements of training were not shown or practised by the staff. People using the service and their relatives informed us that the staff did attend the care visit but times were not set and hence it was not possible to determine if the call visits were late or staff stayed for the full length of time.

Staff were recruited by senior staff through a recruiting procedure which included checking with the disclosure and barring service the candidate was safe to work at the service. However, we saw gaps in staff employment histories and some documents were not signed,

Each person had a care plan containing a risk assessment. Staff were aware of people’s needs and how to support them, however this information was not always fully recorded. The service had a complaints process but no complaints were recorded.

Staff carried out an assessment of people’s needs before they commenced using the service. The information recorded people’s preferences and choices. Some people using the service and their relatives were complimentary about the support provided by members of staff, while expressing concerns about the inconsistency of not knowing which staff were coming to care for their relative.

Staff recorded when necessary how they had supported people to have enough to eat and drink of their choice. However details of choice and how the support was delivered were not always fully recorded. People’s care plans recorded information about support provided by other professionals and when appointments had been made for them by the staff with their permission.

The new manager had commenced an audit to determine if peoples prescribed medicines were being administered and recorded and staff had received training in the administration of medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us that their personal care and support was provided in a way which maintained their privacy and dignity. People spoke positively about the way staff treated them and reported that they received appropriate care. Staff demonstrated a good knowledge and understanding of the people they cared for and supported, such as people with a diagnosis of diabetes or dementia.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Good (published 16 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 28 September 2015. A breach of legal requirements was found as people who used the service were not protected by safe medication procedures and there were issues around the safe administration and recording of people’s medication.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach and also improvements they were to make. We undertook a comprehensive inspection over a number of days and this included 4, 5, 17, 24 and 26 October and 9 November 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. During our visit we found that safer systems were in place to assist people with the management of their medication and to help ensure people received their medication as prescribed. Robust quality assurance systems had also been introduced to monitor people’s medication and take appropriate action when needed.

Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to help protect people. Risk assessments had been completed to help staff to support people with everyday risks and help to keep them safe.

Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. Staff told us that they felt well supported to carry out their work and had received regular supervision and training.

There were generally sufficient numbers of staff, with the right competencies, skills and experience available to help meet the needs of the people who used the service, but this needed to be monitored continually.

Where needed people were supported to eat and drink sufficient amounts to help meet their nutritional needs and staff knew who to speak with if they had any concerns around people’s nutrition. People were supported by staff to maintain good healthcare and were assisted to gain access to a range of healthcare providers, such as their GP, dentists, chiropodists and opticians.

People had agreed to their care and been asked how they would like this to be provided. People said they had been treated with dignity and respect and that care staff provided their care in a kind and caring manner. Assessments had been carried out and care plans had where possible been developed around each individual’s needs and preferences.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. The registered manager had a good understanding of MCA and mental capacity assessments had been requested from the appropriate government body where people were not able to make decisions for themselves.

People knew who to raise complaints or concerns to. The service had a clear complaints procedure in place and people had been provided with this information as part of the assessment process. This included information on the process and also any timespan for response. We saw that complaints had been appropriately investigated and recorded.

The service had an effective quality assurance system and had regular contact with people who used the service. People felt listened to and that their views and opinions had been sought. The quality assurance system was effective and improvements had been made as a result of learning from people’s views and opinions.

People using the service told us that they had had contact with management and that they were able to express their views about the service.

They had been made aware of the complaints procedure and confirmed they had received written documentation during the assessment.

There were systems and procedures in place to help staff identify concerns and respond appropriately to the signs and allegations of abuse.

People we spoke with were complimentary about the service and made positive comments. Comments included, 'Overall I'm very happy with the service,' 'They are always kind and caring and we have a laugh,' 'I can't fault the service in any way,' and, 'I am very pleased with the service.'

People using the service told us that they had had contact with management and that they were able to express their views about the service.

They had been made aware of the complaints procedure and confirmed they had received written documentation during the assessment.

There were systems and procedures in place to help staff identify concerns and respond appropriately to the signs and allegations of abuse. One person reported 'to know she was at ease with them (staff) coming in and out was a great help to all of us.'

People we spoke with were complimentary about the service and made positive comments. Comments taken from the provider's quality assurance included 'All the carers that have tended to 'X's' needs have been of the highest quality and professionalism,' 'Due to the professionalism, efficiency and caring of your carers my health both physically and mentally has improved. I now feel able to make a step towards independence and a more normal life' and 'I am writing to express my grateful thanks for all you kindness, help and support you and your staff have shown in their excellent care of 'X'.'